Sie sind auf Seite 1von 10

Proposed Insured:

Mrs. IRENE

JUANICO

Age 49, Male, Non-smoker


Policyowner or Payor:

Mrs. IRENE

JUANICO

Age 49, Male

Dear IRENE ,
Thank you for your interest in AXAs insurance products. Health MaX is a lifetime health plan which provides coverage for major and
minor critical conditions to ensure that you will have the necessary funding for treatment and recovery. It also gives you lifetime insurance
coverage so you can be sure that your loved ones will be financially protected when the unexpected happens.
Enjoy the following benefits from Health MaX:

Guaranteed Major Critical Conditions coverage* of PHP 1,000,000 if you are diagnosed with any of the 56 specified major
critical conditions.
Guaranteed Minor Critical Conditions coverage** of PHP 200,000 is advanced if you are diagnosed with any of the 18 specified
minor critical conditions. During the life of your policy, you can claim a maximum of two (2) minor critical conditions.
Advanced Health Fund, in the form of guaranteed cash endowments, which you have the option to withdraw for health expenses
such as outpatient treatments and medicines equivalent to PHP 200,000 by age 70 up to PHP 500,000 if left to accumulate, by
age 85.
Guaranteed life insurance coverage* of PHP 1,000,000 from day one of policy issuance.
Guaranteed cash value that can be used should there be unexpected need for funds.

* The Major Critical Conditions and Life Insurance Benefits are equal to 100% of the sum insured if there are no withdrawals made for the Advanced Health Fund and there are
no claims for Minor Critical Conditions benefit. Any claims, withdrawals, or policy loans will be deducted to the benefits payable accordingly.
** The payable Minor Critical Conditions Benefit should come from different Minor Critical Conditions except for (i) Angioplasty and Other Invasive Treatments for Coronary Artery,
and (ii) Carsinoma-in-situ.

BENEFITS
For You
(Living benefits)

For Your Loved Ones


(Death Benefits)

(Major Critical Conditions Benefits)

When you reach Age 75

When you reach Age 75

If the Insured passes away at age 75

Total Living Benefit (Guaranteed Cash Value +


Accumulated Advanced Health Fund with Interest)

Guaranteed Major Critical Conditions Benefit +


Accumulated Advanced Health Fund with Interest

Guaranteed Death Benefit + Accumulated


Advanced Health Fund with Interest

Based on 3% Accumulation

Based on 3%

Based on 3%

Interest RatePHP 777,855

Accumulation Rate..PHP 1,031,855

Accumulation Rate..PHP 1,031,855

Or

Or

Or

Based on 3.5% Accumulation

Based on 3.5%

Based on 3.5%

Interest Rate........PHP 783,537

Accumulation Rate........PHP 1,037,537

Accumulation Rate........PHP 1,037,537

The above is only a summary of the benefits illustration. All the amounts shown are based on the assumption that Advanced Health Fund payouts are left with the Corporation
to earn interest. For more information on the above benefit details, please refer to the succeeding pages.

Page 1 of 10 of Proposal No 18.3.081216.1027614


Printed on: 8/12/2016 1:23:49 PM
Version Number: 2016.18.3 - 01
Plan Code: HMAX65

Created on: 8/12/2016 1:23:40 PM

Expiry Date: 11/12/2016


Date for Next Insurance Age: 10/5/2016

HEALTH MAX PAY-TO-65


for: Mrs. IRENE JUANICO, 49, Male, Non-smoker
SUMMARY OF BENEFITS
Benefits

Benefit Amount (PHP)

Major Critical Conditions Benefit if the Insured is diagnosed


with one of the 56 covered Major Critical Conditions*

1,000,000

Minor Critical Conditions Benefit if the Insured is diagnosed


with one of the covered Minor Critical Conditions**

200,000 up to a maximum of two (2) claims

Death Benefit in the unfortunate event that the Insured


passes away, the beneficiary will receive this amount*
Accumulated Advanced Health Fund ***

1,000,000
200,000
350,000
450,000
500,000

at Age 70
at Age 75
at Age 80
at Age 85

*The benefit amount for Major Critical Conditions and Death Benefits assumes that there are no claims made for Minor Critical Conditions Benefit and there no
withdrawals from the Advanced Health Fund. Any claims, withdrawals, or policy loans will be deducted to the benefit payable accordingly.
**The amount of benefit paid or payable will be deducted from the Major Critical Conditions Benefit and Death Benefit payable under the Basic Plan. Please
refer to the conditions stated on the subsequent pages for the covered illnesses. The payable Minor Critical Conditions Benefit should come from different Minor
Critical Conditions except for (i) Angioplasty and Other Invasive Treatments for Coronary Artery, and (ii) Carcinoma-in-situ.
***The benefit amount for Advanced Health Fund assumes that there are no withdrawals made until age 85. The Advanced Health Fund may increase if left
with the Company to accumulate with interest.

The succeeding pages of this proposal provide more details on the benefits and features of Health MaX.
Again, thank you for your interest in our products. If you have questions, please call me at the number specified below or call the
AXA Customer Care Hotline at Tel. No. 5815-292 or 3231-292

CELISPARA, MARINELA TECSON


30802
022084
639322615162

Page 2 of 10 of Proposal No 18.3.081216.1027614


Printed on: 8/12/2016 1:23:49 PM
Version Number: 2016.18.3 - 01
Plan Code: HMAX65

Created on: 8/12/2016 1:23:40 PM

Expiry Date: 11/12/2016


Date for Next Insurance Age: 10/5/2016

HEALTH MAX PAY-TO-65


for: Mrs. IRENE JUANICO, 49, Male, Non-smoker

PREMIUMS
Plan/Supplements

Cover up to
Age*

HEALTH MAX PAY-TO-65

100
Total Initial Annual Premium
Semi-Annual Premium
Quarterly Premium
Monthly Premium

Sum Insured /
Coverage (PHP)
1,000,000

Annual Premium
(PHP)
52,240.00
52,240.00
27,164.80
14,104.80
4,962.80

*Cover up to Age refers to Termination Age


Notes:
The premium rates for Health MaX are not guaranteed and the Company reserves the right to review and adjust the premium rates from time to time. We will
communicate any change in premium rates by mail or in any other applicable form.
For the premium term of the supplement/s, if any, please refer to the supplement definition indicated in the Summary of the Riders attached to this Proposal.

Page 3 of 10 of Proposal No 18.3.081216.1027614


Printed on: 8/12/2016 1:23:49 PM
Version Number: 2016.18.3 - 01
Plan Code: HMAX65

Created on: 8/12/2016 1:23:40 PM

Expiry Date: 11/12/2016


Date for Next Insurance Age: 10/5/2016

HEALTH MAX PAY-TO-65


for: Mrs. IRENE JUANICO, 49, Male, Non-smoker
ILLUSTRATION OF LIVING BENEFITS
3% Accumulation Rate

End of
Year

Attained
Age

1
2
3
4
5
6
7
8
9
10
15
20
25
21
26
31
36
41
46
51

50
51
52
53
54
55
56
57
58
59
64
69
74
70
75
80
85
90
95
100

Guaranteed
Cash Value
0
1,000
33,000
70,000
109,000
148,000
190,000
231,000
271,000
311,000
512,000
639,000
531,000
458,000
396,000
356,000
328,000
360,000
365,000
500,000

Accumulated
Advanced Health
Fund
0
0
0
0
0
0
0
0
0
0
0
0
200,000
200,000
350,000
450,000
500,000
500,000
500,000
500,000

Accumulated
Advanced Health
Fund with Interest

Total Living Benefit

0
0
0
0
0
0
0
0
0
0
0
0
225,102
200,000
381,855
542,674
679,108
787,273
912,665
1,058,029

0
1,000
33,000
70,000
109,000
148,000
190,000
231,000
271,000
311,000
512,000
639,000
756,102
658,000
777,855
898,674
1,007,108
1,147,273
1,277,665
1,558,029

3.5% Accumulation Rate

Accumulated
Advanced Health
Fund with Interest
0
0
0
0
0
0
0
0
0
0
0
0
229,505
200,000
387,537
560,273
715,428
849,704
1,009,182
1,198,592

Total Living Benefit

0
1,000
33,000
70,000
109,000
148,000
190,000
231,000
271,000
311,000
512,000
639,000
760,505
658,000
783,537
916,273
1,043,428
1,209,704
1,374,182
1,698,592

Product Notes:
The Illustration of Living Benefits presents the amounts payable to the Owner once he/she decides to surrender/terminate the plan.
The Accumulation Rates (3% & 3.5%) are assumed annual rates and are for illustration purposes only, and do not represent maximum or
minimum cash returns.
3. The plan provides Guaranteed Cash Value , which can be paid to the Owner upon termination of the policy prior to death. Any Minor Critical
Conditions benefit claims paid are deductible from the Guaranteed Cash Value. At any time the total Minor Critical Conditions benefit paid is
higher than the Guaranteed Cash Value, the surrender amount is reduced to zero.
4. The Accumulated Advanced Health Fund refers to the accumulated cash endowment benefits available on the 70th, 75th, 80th, and 85th
birthdays of the Insured.
5. The Total Living Benefit is the sum of the Guaranteed Cash Value, and the Accumulated Advanced Health Fund with Interest (if any). The
Advanced Health Fund benefits are to be available 1 day after the end of the policy year.
6. Interest rates on Accumulated Advanced Health Fund are not guaranteed, as these are dependent on the investment performance of the
Corporation.
7. The Illustration assumes that your Advanced Health Fund payouts are left with the Corporation to earn interest. If you decide to withdraw your
Advanced Health Fund, the total living benefits will be reduced accordingly.
8. The plan offers Extended Term Insurance and Premium Loan as premium default options.
9. All amounts are in the currency indicated in the Summary of Benefits page.
10. This proposal is only an illustration of the key features, benefits and assumptions of the recommended insurance plan and does not form part
of the contract. For the complete terms, conditions and limitations of the plan please refer to your policy.
1.
2.

Page 4 of 10 of Proposal No 18.3.081216.1027614


Printed on: 8/12/2016 1:23:49 PM
Version Number: 2016.18.3 - 01
Plan Code: HMAX65

Created on: 8/12/2016 1:23:40 PM

Expiry Date: 11/12/2016


Date for Next Insurance Age: 10/5/2016

HEALTH MAX PAY-TO-65


for: Mrs. IRENE JUANICO, 49, Male, Non-smoker
ILLUSTRATION OF DEATH BENEFITS / MAJOR CRITICAL CONDITIONS BENEFIT
3% Accumulation Rate

Guaranteed
Death
Benefit /
Major Critical
Conditions
Benefit

Accumulated
Advanced Health
Fund

Accumulated
Advanced Health
Fund with Interest

Total Death Benefit


/Major Critical
Conditions Benefit

3.5% Accumulation Rate

End of
Year

Attained
Age

Accumulated
Advanced Health
Fund with Interest

Total Death Benefit


/Major Critical
Conditions Benefit

1
2
3
4
5
6
7
8
9
10
15
20
25

50
51
52
53
54
55
56
57
58
59
64
69
74

1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
800,000

0
0
0
0
0
0
0
0
0
0
0
0
200,000

0
0
0
0
0
0
0
0
0
0
0
0
225,102

1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
1,025,102

0
0
0
0
0
0
0
0
0
0
0
0
229,505

1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
1,000,000
1,029,505

21
26
31
36
41
46
51

70
75
80
85
90
95
100

800,000
650,000
550,000
500,000
500,000
500,000
500,000

200,000
350,000
450,000
500,000
500,000
500,000
500,000

200,000
381,855
542,674
679,108
787,273
912,665
1,058,029

1,000,000
1,031,855
1,092,674
1,179,108
1,287,273
1,412,665
1,558,029

200,000
387,537
560,273
715,428
849,704
1,009,182
1,198,592

1,000,000
1,037,537
1,110,273
1,215,428
1,349,704
1,509,182
1,698,592

The Total Death Benefit / Major Critical Conditions Benefit is the sum of the Guaranteed Death Benefit / Major Critical Conditions Benefit , and the
Accumulated Advanced Health Fund with Interest (if any) payable upon the demise of the Insured or the Insureds diagnosis of any of the 56 Major
Critical Conditions. The Advanced Health Fund payable on the 70th, 75th, 80th and 85th birthdays will be credited 1 day after the end of the policy year
following the 70th, 75th, 80th and 85th birthdays.
The figures presented are based on the key features, benefits and assumptions listed on the Product Notes portion found in the Illustration of Living
Benefits page.

Page 5 of 10 of Proposal No 18.3.081216.1027614


Printed on: 8/12/2016 1:23:49 PM
Version Number: 2016.18.3 - 01
Plan Code: HMAX65

Created on: 8/12/2016 1:23:40 PM

Expiry Date: 11/12/2016


Date for Next Insurance Age: 10/5/2016

HEALTH MAX PAY-TO-65


for: Mrs. IRENE JUANICO, 49, Male, Non-smoker
MAJOR CRITICAL CONDITIONS COVERED
Major Critical Conditions
Group 1 Cancer
1.

Group 6 Critical Conditions related to the digestive system

Cancer

39.
40.
41.
42.

Group 2 Critical Conditions related to organ failure


2.
3.
4.
5.
6.
7.
8.
9.

Group 7 Critical Conditions related to immunology and rheumatology

Chronic Adrenal Insufficiency (Addison's Disease)


Chronic and Irreversible Kidney Failure
Chronic Liver Disease
Coma
End Stage Lung Disease
Loss of Independent Existence#
Major Organ Transplantation
Medullary Cystic Disease

43.
44.
45.

Group 3 Critical Conditions related to heart and blood vessels


10.
11.
12.
13.
14.
15.
16.
17.
18.

Cardiomyopathy
Coronary Artery Disease Requiring Surgery
Dissecting Aortic Aneurysm
Eisenmengers Syndrome
Heart Attack
Heart Valve Surgery
Primary Pulmonary Arterial Hypertension
Severe Infective Endocarditis
Surgery to Aorta

Group 4 Critical Conditions related to the nervous system


19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.

Amyotrophic Lateral Sclerosis


Apallic Syndrome
Bacterial Meningitis
Benign Brain Tumor
Blindness
Brain Damage^
Encephalitis
Motor Neuron Disease
Multiple Sclerosis
Muscular Dystrophy
Paralysis
Poliomyelitis
Progressive Bulbar Palsy
Progressive Supranuclear Palsy^
Spinal Muscular Atrophy
Stroke
Tuberculosis Meningitis

Group 5 Critical Conditions related to blood


36.
37.
38.

Chronic Relapsing Pancreatitis


Fulminant Hepatitis
Severe Crohns Disease
Severe Ulcerative Colitis
Severe Rheumatoid Arthritis
Systemic Lupus Erythematosus (S.L.E.) with Lupus Nephritis
Systemic Scleroderma

Group 8 Critical Conditions related to neurological degeneration


46.
47.
48.

Alzheimers Disease
Parkinsons Disease
Severe Creutzfeld-Jacob Disease (CJD)

Group 9 Critical Conditions related to the musculoskeletal system


49.
50.
51.
52.

Amputation of Both Feet due to Complication from Diabetes


Major Burns
Necrotizing Fasciitis
Severance of Limbs

Group 10 Other Critical Conditions

AIDS / HIV due to Blood Transfusion


Aplastic Anemia
Occupationally Acquired AIDS / HIV

53. Deafness (loss of hearing)


54. Elephantiasis
55. Loss of Speech
56. Terminal Illness
#To be eligible to receive a benefit under this Major Critical Condition, the Insured must be between age 15 and age 75 at the time of first diagnosis.
^To be eligible to receive a benefit under this Major Critical Condition, the Insured must be above age 5 at the time of first diagnosis.

MINOR CRITICAL CONDITIONS COVERED


Minor Critical Conditions
Group 1 Children Minor Critical Conditions~

Group 2 Carcinoma-in-situ / Early Stage Cancer


Group 3 Angioplasty
Group 4 Other Minor Critical Conditions

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Dengue Hemorrhagic Fever (Grades III and IV)


Hemophilia A and Hemophilia B
Insulin Dependent Diabetes Mellitus
Kawasaki Disease
Osteogenesis Imperfecta
Rheumatic Fever with Valvular Impairment
Stills Disease
Wilsons Disease
Carcinoma-in-situ at Breast, Cervix Uteri, Uterus, Ovary, Fallopian Tube,
Vagina or Testicles
Early Stage Cancer of Prostate

11.

Angioplasty and Other Invasive Treatments for Coronary Artery Disease

12.
13.
14.
15.
16.
17.
18.

Aortic Aneurysm
Chronic Auto-immune Hepatitis
Facial Reconstructive Surgery for Injury due to Accident
Hepatitis with Cirrhosis
Insertion of Pacemaker or Defibrillator
Skin Transplantation due to Accidental Burning
Systemic Lupus Erythematosus (S.L.E.)

~Only an Insured aged under 22 on the 1st diagnosis of these minor Critical Conditions is eligible to claim for the relevant benefit.
Note : The critical condition must occur 60 days after the policys effective date for the corresponding Major Illness or Minor Illness Benefit to be payable. Benefits relating to Major
and Minor Critical Conditions are payable according to the definitions of Major and Minor Critical Conditions Benefits as set out in the policy contract.

Page 6 of 10 of Proposal No 18.3.081216.1027614


Printed on: 8/12/2016 1:23:49 PM
Version Number: 2016.18.3 - 01
Plan Code: HMAX65

Created on: 8/12/2016 1:23:40 PM

Expiry Date: 11/12/2016


Date for Next Insurance Age: 10/5/2016

HEALTH MAX PAY-TO-65


for: Mrs. IRENE JUANICO, 49, Male, Non-smoker

QUICK GUIDE TO COMMON CRITICAL CONDITIONS


COVERED UNDER YOUR HEALTH PLAN
Health Max covers a total of 56 major and 18 minor critical conditions. Here is a quick reference for the 15 most common major critical
conditions and 5 minor critical conditions.
TOP 15 ILLNESSES COVERED UNDER MAJOR CRITICAL CONDITIONS
CONDITION
WHAT IS COVERED
1. Cancer
Cancer, beginning stage 1* to stage 4, which meets
the following criteria:

A malignant tumor

Confirmed by biopsy report

Certified by an appropriate specialist


Types of Cancer include: Leukemia, Malignant
Lymphoma, Hodgkins Disease, Malignant bone
marrow disorders, Metastatic cancers
*except for certain stage 1 cancer classifications in
specified organs
2. Stroke

Evidence of irreversible death of brain cells due to a


blocked artery or ruptured blood vessel.

3. Heart Attack

4. Coronary Artery Bypass


Graft Surgery (CABG)
5. Heart Valve Surgery

6. Major Organ
Transplantation

7. Chronic and Irreversible


Kidney Failure

8. Alzheimers Disease

Occurrence of death of a portion of the heart muscle


as a result of inadequate blood supply to the relevant
area.
An open heart surgery should have already been
done to correct the narrowing or blockage of one or
more coronary arteries with bypass grafts.
An open heart valve surgery should have already
been done to replace or repair one (1) or more heart
valves, as a consequence of defects.
Recommendation from a specialist to undergo
transplant for any of the following organs:

heart, lung, liver, kidney, pancreas, or human


bone marrow
The following symptoms must be present:

Both kidneys are characterized with irreversible


failure to function

Has already started regular renal dialysis

Is either awaiting or has already undergone


kidney transplant
Evident deterioration or loss of cognitive and/or
intellectual capacity, due to irreversible failure of
brain function.

WHAT IS NOT COVERED


Tumors defined as benign, or
pre-malignant
Non-invasive cancers in situ (pre-cancer or
Stage 0 cancer)
Certain Stage 1 cancer classifications in
the contract for the following organs:
ovary, prostate, urinary bladder, and
thyroid
Any skin cancer other than malignant
melanoma
Chronic Lymphocytic Leukemia less than
Rai Stage 3.
Transient Ischaemic Attacks (TIA) or
temporary stroke-like signs and symptoms
Brain damage due to an accident or injury,
infection, vasculitis (inflammation of blood
vessels), inflammatory disease or
migraine
Disorders of the blood vessels affecting
the eye including infarction of the optic
nerve or retina
Ischemic disorders of the vestibular
system
Silent stroke with no symptoms
Any chest pain (i.e. angina) without
evidence of death or injury of the heart
muscle
All other procedures which do not require
open chest surgery and actual placement
of bypass graft
All repairs conducted through intra-arterial
catheter procedures

Other transplants for organs not


mentioned in the list

At least one kidney is still functioning and


regular dialysis is not required.

Dementia relating to alcohol, drug abuse


or AIDS

Note: The critical condition must occur 60 days after the policys effective date for the corresponding Major Illness or Minor Illness Benefit to be payable.
Benefits relating to Major and Minor Critical Conditions are payable according to the definitions of Major and Minor Critical Conditions Benefits as set out
in the policy contract.

Page 7 of 10 of Proposal No 18.3.081216.1027614


Printed on: 8/12/2016 1:23:49 PM
Version Number: 2016.18.3 - 01
Plan Code: HMAX65

Created on: 8/12/2016 1:23:40 PM

Expiry Date: 11/12/2016


Date for Next Insurance Age: 10/5/2016

HEALTH MAX PAY-TO-65


for: Mrs. IRENE JUANICO, 49, Male, Non-smoker
TOP 15 ILLNESSES COVERED UNDER MAJOR CRITICAL CONDITIONS (continuation)
CONDITION
WHAT IS COVERED
9. Parkinsons Disease
Definitive signs of progressive and permanent
neurological impairment, evidenced by permanent
inability to perform at least three (3) out of six (6)
Activities of Daily Living (ADLs)1, in spite of being on
optimal medication.

WHAT IS NOT COVERED


Drug induced, accidental, or toxic causes
of Parkinsons Disease

Evidence of inflammation of the brain membranes or


spinal cord, resulting in significant and permanent
neurological deficit.
Presence of a life threatening, non-cancerous tumor
in the brain. If it cannot be removed through surgery,
the tumor should cause significant and permanent
neurological deficit persisting for at least 6
consecutive months.

Viral Meningitis

Cysts, granulomas (inflammations),


malformations in, or of, the arteries or
veins of the brain, hematomas (collection
of blood outside the blood vessels) and
tumors in the pituitary gland or spinal cord

Inability of two (2) or more limbs to function totally


and permanently due to injury or disease of the
spinal cord or brain.

Paralysis in 1 limb

Independent capability to perform 4 or


more ADLs

14. Severe Rheumatoid


Arthritis

*Only Insured aged between 15 and 75 on first


diagnosis is eligible to receive a benefit under this
illness
Evidence of extensive joint deformity of two (2) or
more of the following joint areas: hands, wrists,
elbows, knees, hips, ankle, cervical spine or feet; and
inability to perform at least 2 Activities of Daily Living
(ADLs)1.

Only one joint area is affected and the


Insured can still perform 3 or more ADLs.

15. Severance of Limbs

The condition must be present for at least six (6)


months.
Total and irrecoverable loss of two (2) or more limbs
due to illness or accident only. This includes the loss
of use of both hands or both feet or the use of one
(1) hand and one (1) foot.

Loss of either one (1) hand or one (1) foot


only.

10. Bacterial Meningitis

11. Benign Brain Tumor

12. Paralysis

13. Loss of Independent


Existence

Those classified as Diplegia (paralysis affecting like


parts on both sides of the body, such as both arms or
both legs), Hemiplegia (paralysis of one side of the
body), and Quadriplegia (paralysis of all four limbs)
are included.
Permanent inability to perform at least three (3)
Activities of Daily Living (ADLs)1, as certified by a
medical specialist and/or AXAs medical director.

Activities of Daily Living are as follows: (1) Washing - wash in the bath or shower (including getting into and out of the bath or shower) or wash
satisfactorily by other means; (2) Dressing - put on, take off, secure, and unfasten all garments and, as appropriate, any braces, artificial limbs, or other
surgical appliances; (3) Transferring - move from a bed to an upright chair or wheelchair or vice versa; (4) Mobility - move indoors from room to room on
level surfaces; (5) Toileting - use lavatory or otherwise manage bowel and bladder functions so as to maintain a satisfactory level of personal hygiene;
and (6) Feeding - feed oneself once food has been prepared and made available.
1

Note: The critical condition must occur 60 days after the policys effective date for the corresponding Major Illness or Minor Illness Benefit to be payable.
Benefits relating to Major and Minor Critical Conditions are payable according to the definitions of Major and Minor Critical Conditions Benefits as set out
in the policy contract.
NOTE: Benefits relating to major and minor Critical Conditions are payable according to the definitions set out in the policy contract .

To see the complete list of the 56 covered major critical conditions and their detailed coverage, please visit
http://failproof.axa.com.ph/Health-Max.

Page 8 of 10 of Proposal No 18.3.081216.1027614


Printed on: 8/12/2016 1:23:49 PM
Version Number: 2016.18.3 - 01
Plan Code: HMAX65

Created on: 8/12/2016 1:23:40 PM

Expiry Date: 11/12/2016


Date for Next Insurance Age: 10/5/2016

HEALTH MAX PAY-TO-65


for: Mrs. IRENE JUANICO, 49, Male, Non-smoker
TOP 5 ILLNESSES COVERED UNDER MINOR CRITICAL CONDITIONS
CONDITION
WHAT IS COVERED
1. Carcinoma-in-situ (CIS)
Cells on biopsy have not yet spread and invaded
commonly known as
surrounding tissues or are contained to the place of
Pre-Cancer or Stage 0 cancer
origin.

WHAT IS NOT COVERED


Carcinoma-in-situ located in organs not
specified in the definition

Only CIS reported in any of the following organs may


be covered: Cervix Uteri, Uterus, Breast, Vagina,
Fallopian Tube, Ovary, Testicles

2. Angioplasty and other


Invasive Treatments for
Coronary Artery Disease

Maximum of 2 claims, with the 2nd CIS claim for any


of the other remaining organs listed and not from the
same organ as that of the 1st CIS claim.
Have already undergone Angioplasty (procedure to
widen blocked or narrowed coronary arteries),
atherectomy (procedure to remove plaque from the
inside of a blood vessel) or laser treatment to correct
narrowings.

Angioplasty, atherectomy, or laser


treatment has not yet been performed
The procedure was done only for the
branches of the major coronary arteries

Covered procedure should involve any of the


following coronary vessels: Left main stem artery,
Left anterior descending artery, Circumflex artery,
Right coronary artery except their branches

3. Early Stage Cancer of


Prostate

4. Hepatitis with Liver


Cirrhosis

5. Dengue Hemorrhagic
Fever

Maximum of 2 claims, with the 2nd procedure done


in a narrowed vessel of a major coronary artery.
A prostate malignant tumor histologically described
as TNM classification T1a, T1b, T1c or which is of
another equivalent classification. Diagnosis must be
supported by a biopsy report.
Inflammation of the liver by the Hepatitis virus
leading to cirrhosis (healthy liver tissue is replaced
with scar tissue, eventually preventing the liver from
functioning properly).
The liver biopsy must show score 4 in Metavir
grading system or score 13-18 in Knodell score
system or any other imaging test establishing
existence of cirrhosis.
Dengue Grades III and IV

The condition does not satisfy all of the


specified criteria.

Liver diseases due or related to alcohol


abuse

Dengue Hemorrhagic Fever I and II

*Only Insured aged 21 and below on first diagnosis


is eligible to receive a benefit under this illness.
Note: The critical condition must occur 60 days after the policys effective date for the corresponding Major Illness or Minor Illness Benefit to be payable.
Benefits relating to Major and Minor Critical Conditions are payable according to the definitions of Major and Minor Critical Conditions Benefits as set out
in the policy contract.

To see the complete list of the 56 covered major critical conditions and their detailed coverage, please visit
http://failproof.axa.com.ph/Health-Max.

Page 9 of 10 of Proposal No 18.3.081216.1027614


Printed on: 8/12/2016 1:23:49 PM
Version Number: 2016.18.3 - 01
Plan Code: HMAX65

Created on: 8/12/2016 1:23:40 PM

Expiry Date: 11/12/2016


Date for Next Insurance Age: 10/5/2016

HEALTH MAX PAY-TO-65


for: Mrs. IRENE JUANICO, 49, Male, Non-smoker

DECLARATIONS AND ACKNOWLEDGEMENTS


Declarations
I confirm having read and understood the information contained in the Illustration of Living Benefits Page and the Illustration of
Death Benefits / Major Critical Conditions Benefits Page.

Acknowledgement of Variability
I acknowledge that:
I have applied with AXA Philippines a Whole Life policy, and have reviewed the illustration(s) that shows how a life insurance
policy performs using the companys assumptions based on Insurance Commissions guidelines on interest rates.
I understand that only those values described as guaranteed, if any, are guaranteed. All other policy values can change and may
probably be different from those illustrated to me. Actual values may be higher or lower depending on the dividend rates actually
earned.
I understand that interest rate on accumulated Advanced Health Fund change from year to year and since these are affected
by the companys mortality experience, investment returns, expenses, and taxes, and that AXA Philippines will advise me of the
actual amount of the interest rate, if any.
I understand that the illustration(s) given to me will not become part of any issued policy, as these are provided only to show how
policy benefits would change over time under a specific set of assumptions.

CONFORME:

These declarations and acknowledgements are made with the


knowledge of the AXA representative whose signature appears below:

____________________________
Applicant/Policy Owner
Signature over Printed Name

_____________________
Date

____________________________________
Financial Advisor/Financial Executive
Signature over Printed Name

_____________________
Date

General Disclaimer
All information and opinions provided are of a general nature and for information purposes only. The information and any opinions herein are based upon
sources believed to be reliable, and AXA Philippines, its officers and directors make no representations or warranty, expressed or implied, with respect to
the correctness, completeness of the information and opinions in this document. Please carefully read the policy and endorsements and consider the
risks, charges and expenses before buying the policy. You should seek independent professional advice from your financial, tax, accounting or legal
consultant before buying the Policy.

THIS FINANCIAL PRODUCT OF AXA PHILIPPINES IS NOT INSURED BY THE PHILIPPINE DEPOSIT
INSURANCE CORPORATION (PDIC) AND IS NOT GUARANTEED BY METROBANK OR PS BANK.

Page 10 of 10 of Proposal N 18.3.081216.1027614


Printed on: 8/12/2016 1:23:49 PM
Version Number: 2016.18.3 - 01
Plan Code: HMAX65

Created on: 8/12/2016 1:23:40 PM

Expiry Date: 11/12/2016


Date for Next Insurance Age: 10/5/2016